NR 324 Adult Health I

Workshop
Care of Patients with Musculoskeletal Disorders
Craig W. Cowan, RN MSN CCRN CNRN
Fractures
Traction
Hip FX
Hip FXs
Hip FXs
Joint Replacement
Amputations
Rheumatoid Arthritis
Sprains and Strains
Crutches
Tendons VS. Ligaments
Osteoporosis
Osteoporosis
 Questions
Alendronate (Fosamax) is prescribed for a patient with osteoporosis. The
nurse teaches the patient that

A. the drug must be taken with food to prevent GI side effects.

B. all of the bisphosphonates prevent calcium from being taken from the bones.

C. lying down after taking the drug prevents light-headedness and dizziness.

D. taking the drug with milk enhances the absorption of calcium from the bowel.

B: Bisphosphonates should be taken with a full glass of water 30 minutes before

food or other mediations, and the patient should remain upright for at least 30
minutes after administration.
 Questions
When caring for a patient following a lumbar laminectomy, the nurse
should

A. place a pillow between the patient’s legs before turning to the side.

B. elevate the head of the bed 30 degrees and then turn the patient to the side.

C. ask the patient to flex the knees and push the heels into the bed during
turning.

D. have the patient grasp the side rail on the opposite side of the bed to help with
turning.

A: Rationale: Place pillows between the legs before turning the patient and when
in the side-lying position to provide comfort and ensure alignment.
 Questions
Which of the following patients would be at greatest risk for developing
osteoporosis?

A. A 73-year-old male patient who has five alcoholic drinks per week and limits sun exposure
to prevent recurrence of skin cancer.

B. A 55-year-old patient who recently had a hysterectomy with bilateral salpingo-

oophorectomy and refuses estrogen therapy.

C. An 84-year-old male patient who has recently been diagnosed with hypothyroidism and is
prescribed levothyroxine (Synthroid).

D. A 69-year-old female patient who had a renal transplant 5 years ago and has been taking
prednisone to prevent organ rejection.

D: Risk factors for osteoporosis include advanced age, female gender, long term use of
corticosteroids, as well as others.
 Questions
A nurse is caring for multiple clients on an orthopedic unit with the help
of an LPN. Which activity is best to delegate to the LPN?

A. Inform the health care provider on the unit that a client with rib
fractures has a suspected PE
B. Assessing the casted arm of a client who is complaining of paresthesias
and pale, cold fingers.
C. Completing a wet to dry dressing change for a client who had a
fasciotomy of the leg yesterday
D. Reinforcing physical therapy teaching on pendulum exercises for a
client with a fractured humorus

D: An LPN may reinforce education

 Questions
Postoperatively, which nursing assessment should receive the
highest priority when caring for an adult client who has a
compound distal radial fracture stabilized with an external fixator?

A. Checking for bladder distention

B. Assessing the wound for drainage
C. Assessing the external fixator for sharp points
D. Checking the neurovascular status of the extremity

D: The nurse is concerned about compartment syndrome, vessel

and nerve damage will have priority over the other issues.
 Questions
A client has been receiving enoxaparin 70mg SC bid following a total hip
replacement. Which finding should lead a nurse to conclude that the
client may be experiencing an adverse reaction from the medication?

A. Ecchymosis is noted on the abdomen

B. The client develops a DVT
C. The INR is 3.5 and the dressing has bright red blood
D. The client reports a “popping” sensation when crossing his legs

C: An adverse reaction for an anticoagulant would be to have an INR

greater than 2 times the normal value. The theraputic value would be 3.0
 Questions
Which intervention would a nurse least likely be expected to expected to
perform when caring for a client with an upper extremity amputation?

A. Reapplying the spiral bandage using a spiral technique from the distal to the
proximal end of the residual hub
B. Teaching a family member prior to discharge how to apply an elastic residual
hub shrinker
C. Reinforcing client teaching of initially pushing the residual limb into a soft
pillow
D. Immediately postoperatively placing a large tourniquet at the clients
bedside to apply to the residual limb if needed

A: A figure 8 rather than a spiral technique should be used to help shape the
residual limb and reduce edema.
 Questions
An LPN is reporting his observations to an RN. Based on the report, which
client should the RN assess immediately?

A. The client, 2 hours following a total knee replacement, who has a 100ml
bloody drainage in the suction container of an autotransfusion drainage
system
B. The client with a crush injury to the arm who was given another analgesic
and a skeletal muscle relaxant for throbbing, unrelenting pain
C. The client in a new body cast who was turned every 2 hours and supported
with pillows
D. The client with an external fixator on the left leg having serous drainage
from the pin sites

B: These could be the first S/S of compartment syndrome.

 Questions
Which physician order should be a priority for a nurse caring for a client
involved in a motor vehicle accident who sustained an unstable pelvic
fracture?

A. Urinalysis
B. Blood alcohol level
C. CT scan of pelvis
D. Two units of cross matched whole blood

D: Typing and cross matching blood takes time. The pelvis is a very
vascular area and susceptible to bleeding. 20% of persons with unstable
pelvic fractures require more than 15 units of blood products in the first 24
hours after injury.
 Questions
A nurse is assessing an older adult in Buck’s traction to temporarily
immobilize a fracture of the proximal femur prior to surgery. Which
finding requires the nurse to intervene immediately?

A. Reddened area on the sacrum

B. Voiding concentrated urine, 50 ml/hr
C. Capillary refill 3 seconds, dorsiflexion and sensation intact, pedal
pulses palpable
D. Lower leg secure in traction boot, and ropes, pulleys and 5-lb
weight hanging freely

A: This is first sign of a pressure ulcer